Fear of falling is an emerging public health problem because it is an independent risk factor for falls and can lead to activity restriction, isolation, functional decline, and disability, even in the absence of a fall. Fear of falling affects 20-43% of community-dwelling older adults, with an incidence of 22.5%, making research in this area critically important to our aging population. Evidence for managing fear of falling is limited because few interventions have been tested or effective in reducing fear of falling in community-dwelling older adults. A theoretically-based cognitive behavioral intervention, A Matter of Balance, which addresses perceptions of falling, teaches fall prevention techniques, and encourages exercise and activity participation shows promise in reducing fear of falling. However, treatment outcomes were not sustained, and innovative strategies are needed for assisting older adults to adopt long-term behavior changes. The broad, long-term objective of this program of research is to develop cost-effective, community- based interventions for reducing fear of falling and subsequent disability in older adults. Specific aims of this project are to: 1) determine the effect of the coaching-enhanced A Matter of Balance (MOB) intervention on: a) fear of falling, b) falls, c) functional status, d) activity participation, and e) exercise behavior in community-dwelling older adults with a fear of falling at completion of the 8- week intervention, and at 3,6, 9, and 12 months; and 2) evaluate the feasibility and acceptability of the coaching-enhanced MOB intervention and control conditions. A randomized control trial design will be used. Participants will include 40 community-dwelling older adults with fear of falling who have either made changes in their home environment or activities or have balance difficulties. Study results will provide effect sizes and pilot data essential for designing a larger clinical trial to further test the effectiveness of the coaching-enhanced Matter of Balance intervention. PUBLIC HEALTH RELEVANCE: Fear of falling is an emerging public health problem because it is a risk factor for falls and can lead to activity restriction, isolation, functional decline, and disability, even in the absence of a fall. The proposed study is a pilot test of a fear of falling education intervention with an innovative coaching component and will examine the effects of the intervention on fear of falling, functional status, activity participation and exercise behavior in community-dwelling older adults with a fear of falling. Study results will provide pilot data essential for designing a larger clinical trial to further test the effectiveness of the fear of falling education and coaching intervention. [unreadable] [unreadable] [unreadable]